The therapeutic alliance: a psychoanalytic perspective.

Psychoanalysis has long distinguished between the transference neurosis and that part of the communication between therapist and patient which depends upon a relatively intact part of the patient's ego. It has been proposed that it is this capacity of the patient that sustains the difficult work of dealing with communications which are the consequence of transference, and which often threaten the viability of the treatment. This quality has been referred to variously as the unobjectionable positive transference, rational transference, mature transference, therapeutic alliance and working alliance.

The prescription of psychotherapy.

This paper outlines a format for the evaluation of patients for whom intensive dynamic psychotherapy is being considered as a treatment modality. Such an evaluation includes a traditional descriptive diagnostic assessment leading to the establishment of a conventional nosological diagnosis. This is followed by a descriptive, developmental evaluation which pays close attention to the levels of ego development, at the same time attempting to assess the mutual influences between it and several other important lines of development which may not all have reached similar phases of maturation.

The teaching and learning of psychotherapy in a general hospital.

A general teaching hospital provides an excellent setting for the teaching of psychiatric residents. The Canadian model for a teaching network, including general and specialty hospitals, allows for special interests to develop within given hospitals. A department of psychiatry which chooses the teaching of psychotherapy as a special interest is examined.

Clinical aspects of the countertransference.

Some of the ways in which countertransference reactions may manifest themselves are outlined in a series of case examples, which also illustrate how the therapist's recognition of the countertransference brought to light hitherto unrecognized transference resistances, thereby permitting their interpretation and progress in therapy. A number of technical steps for dealing with the countertransference are outlined, along with the reminder that while attention to the countertransference is important the therapist's principal focus must remain with the patient.

Growth hormone and cortisol responses, tranquillizer usage, and their association with survival from myocardial infarction.

Sixty-six patients consecutively admitted to a Coronary Care Unit with a diagnosis of myocardial infarction were evaluated physically, psychologically, and neuroendocrinologically. Records were also kept of appetite and drug intake. Serum cortisol and growth hormone, physical, and mood variables were evaluated daily and the neuroendocrine measures were also taken serially at the time of removal from the cardiac monitor.